Managed Care Contract Manager (Medicaid Health Systems Administrator 1)

What You Will Do At ODM:

Office: Managed Care

Bureau: Contract Management & Compliance

Classification: Medicaid Health Systems Administrator 1 (PN: 20089575)

Job Overview:

As the Managed Care Contract Manager in the Office of Managed Care, Ohio Department of Medicaid (ODM), your responsibilities will include:

• Managing program information and conducting analyses to inform and direct policy changes and updates
• Conducting evaluations for managed care plans
• Performing research and answering questions related to legislative and policy initiatives such as implementation and ongoing assessment of new programs, populations and/or initiatives
• Leading on managed care related contract issues, implementations, and targeted reviews
• Working with the Managed Care plans to identify areas of concern and provide technical assistance as needed.
• Reviewing and approving submitted reports and deliverables outlined in the Managed Care Provider Agreements
• Communicating any compliance actions to the assigned Managed Care Plans

There are 4 MyCare Plans and 7 Managed Care Organizations (MCOs) that you will be working with.

MyCare Plans:

• Anthem Blue Cross and Blue Shield
• Buckeye Health Plan
• CareSource
• Molina HealthCare of Ohio, Inc.

Managed Care Organizations (MCOs)

• AmeriHealth Caritas Ohio, Inc.
• Anthem Blue Cross and Blue Shield
• Buckeye Health Plan
• CareSource
• Humana Healthy Horizons in Ohio
• Molina HealthCare of Ohio, Inc.
• UnitedHealthcare Community Plan

Completion of graduate core program in business, management or public administration, public health, health administration, social or behavioral science or public finance; 12 months experience in the delivery of a health services program or health services project management (e.g., health care data analysis, health services contract management, health care market & financial expertise; health services program communication; health services budget development, HMO & hospital rate development, health services eligibility, health services data base analysis).

Or 12 months experience as a Medicaid Health Systems Specialist, 65293.

• Or equivalent of Minimum Class Qualifications for Employment noted above.

Technical Skills: Health Administration

Professional Skills: Collaboration, Confidentiality, Continuous Improvement, Innovation, Verbal Communication, Written Communication